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pdfINSTRUCTIONS FOR NOTICE OF CHANGE IN STUDENT STATUS
NOTE: All items not mentioned are considered self-explanatory.
Item 2 - Enter the VA FILE NUMBER: This is usually the veteran’s
claim number or social security number.
Item 2 - If the claimant is receiving CHAPTER 35 benefits, enter his
or her SUFFIX. (This is a letter (A, B, etc.) designation.)
Item 4 - If the claimant is receiving benefits transferred to him or her
enter the claimant’s SOCIAL SECURITY NUMBER.
Item 5 - DATES OF TERM AFFECTED: Enter the begin and end
dates for the term in which the change in student status occurred.
Item 6A - LAST DATE OF ATTENDANCE: Enter the actual last
date of attendance. For college level courses, you may use one of the
following methods to determine the last date of attendance: (1)
attendance records; (2) grading reports; (3) last date on which
examination or other papers filed; (4) last day of activity in the
instructor’s records; or (5) a statement from the student as to the last
day of his or her attendance.
Item 6B - REASON FOR TERMINATION: (Check the appropriate
box.)
WITHDRAWAL DURING DROP PERIOD: Check this box for
withdrawals during an officially designated drop period of not more
than 30 days. Do not use this box for withdrawals after the drop
period or more than 30 days after the start of the term, whichever is
earlier.
WITHDRAWAL AFTER DROP PERIOD - NONPUNITIVE
GRADE ASSIGNED: A nonpunitive grade is any grade not used to
compute graduation requirements. A nonpunitive grade is the
equivalent of an audited course for purposes of advancement toward
graduation. Typical examples are "W" (withdrawal) and "NC" (no
credit). Complete Items 9 & 11.
WITHDRAWAL AFTER DROP PERIOD - PUNITIVE GRADE
ASSIGNED: A punitive grade is one assigned a value when
computing graduation requirements. A common example is an "F"
(failing) grade which has a quality point value of "zero."
UNSATISFACTORY
ATTENDANCE,
CONDUCT,
OR
PROGRESS: Check this box for failure to meet the school’s
standards of attendance, conduct, or progress. In Item 6A, show the
last date attendance, conduct, or progress was satisfactory.
OTHER (Explain in Item 12, Remarks): Check this box for any
termination reason not shown.
WITHDRAWAL OR INTERRUPTION (Noncollege Degree
Programs (NCD)): "Noncollege Degree Programs" refers to
programs such as diploma or certificate programs that do not lead to
a standard college degree. Check this box if a student terminates or
interrupts a noncollege degree program that is not offered on a term,
quarter or semester basis. (The program may be offered on a block,
unit or clock basis.) For such programs, report in Item 12, Remarks,
the first date from which no credit accrued toward graduation.
If the nondegree program is offered on a term, quarter, or semester
basis, check the most appropriate of the remaining boxes.
Item 6C - LAST DATE CREDIT ACCRUED (For NCD Only): For
NCD programs operating on a block, unit or clock basis, enter the
last date the student accrued credit toward graduation.
Item 7B - TYPE OF ADJUSTMENT:
INCREASE: Check this box to show an increase in credit hours,
clock hours, or high school units.
REDUCTION DURING DROP PERIOD: Check this box for
reductions during an officially designated drop-add period of not
more than 30 days.
REDUCTION AFTER DROP PERIOD - NONPUNITIVE GRADE
ASSIGNED: See Instruction Item 6B for a definition of
"nonpunitive." Complete Items 9 & 11.
VA FORM
NOV 2008
22-1999b
REDUCTION AFTER DROP-ADD PERIOD - PUNITIVE GRADE
ASSIGNED: See Instructions Item 6B for a definition of "punitive."
STUDENT COMPLETED TERM BUT NONPUNITIVE GRADES
ASSIGNED FOR ONE OR MORE COURSES: Check this box if a
student completed a term but received nonpunitive grades for one or
more courses. EXAMPLE: A student completes 12 credits and
receives "W" grades for 6 credits. Enter the last day of the term in
Item 7A. Enter 12 in Item 7C and 6 in Item 7D.
REDUCTION (Noncollege Degree Programs) "Noncollege Degree
Programs": refers to programs such as diploma or certificate
programs that do not lead to a standard college degree. Check this
box if a student reduces his or her course load in a noncollege degree
program that is not offered on a term, quarter or semester basis. (The
program may be offered on a block, unit or clock basis.) For such
programs, report in Item 12, Remarks, the first date from which no
credit accrued toward graduation.
If the nondegree program is offered on a term, quarter, or semester
basis, do not check this box. Check the most appropriate of the
remaining boxes.
OTHER (Explain in Item 12 Remarks): Check this box for any
adjustment type not shown. EXAMPLES: (a) Incomplete "I"
grade(s) not converted to credit grade(s) within one calendar year, or
(b) Incomplete "I" grade converted to credit grade(s) or to punitive,
failing grade(s).
Items 7C and 7D - CREDIT HOURS: Show a breakdown of credit
hours as shown on VA Form 22-1999, Enrollment Certification, if
necessary. If the student is taking noncredit, remedial, deficiency, or
independent study courses, show these hours in addition to the credit
hours.
EXAMPLE:
Before Adjustment
After Adjustment
6 credit hours
+
3 deficiency hours
3 credit hours
+
3 deficiency hours
Item 8 - CHARGES FOR PERIOD OF ENROLLMENT: When
required, report the customer charges for the ADJUSTED load only.
EXAMPLE: A student starts a term at full-time, but reduces to less
than half-time in the third week.
Item 9 - PREVIOUS CERTIFICATIONS FOR SUBSEQUENT
TERMS: Check "yes" if there are terms, previously certified, which
follow the term of the termination or adjustment and are not affected
by the termination or adjustment. Check "no" if there are terms,
previously certified, which follow the term of the termination or
adjustment and are no longer valid.
Item 10 - CALL-UP TO ACTIVE DUTY: If the termination or
adjustment occurs because the student has been called to active duty,
please indicate whether credit has been granted for interrupted
coursework by checking the appropriate box.
Item 11 - MITIGATING CIRCUMSTANCES: These are unavoidable or unexpected events that directly interfere with a student’s
pursuit of a course and are beyond the student’s control. Students
must submit corroborative evidence to substantiate their reasons for
being unable to complete a course or courses, or receiving a
nonpunitive grade.
Item 12 - REMARKS: Use this space to provide any needed
clarification. It is important to clarify the student’s status for terms
after the one in which a change occurred. EXAMPLE: A student
certified for the entire school year withdraws during the fall term. If
the student is still enrolled for the spring term, enter that information
in Item 12, "Remarks."
Item 13C - NAME AND ADDRESS OF SCHOOL OR TRAINING
ESTABLISHMENT (Include facility code): Enter the complete
name and address of the school or training establishment and the
facility code. Facility codes contain 8 numbers which identify a
particular school or training establishment. If you do not know your
facility code, contact the VA Education Liaison Representative.
Entering the facility code will help VA to be sure that your school is
properly shown in the student’s record.
PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than
what has been authorized under the Privacy Act of 1974 or Title 38 CFR 1.576 for routine uses (i.e., award of
benefits) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education and
Vocational Rehabilitation Records - VA, published in the Federal Register. Your obligation to respond is
required to obtain benefits. We cannot pay the student any further education benefits until we receive this
information (38 U.S.C. 3684). Information submitted is subject to verified through computer matching
programs with other agencies.
RESPONDENT BURDEN: VA may not conduct or sponsor, and respondent is not required to respond to this
collection of information unless it displays a valid OMB Control Number. Public reporting burden for this
collection of information is estimated to average 10 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. We need this information to determine whether educational benefits
should be increased, decreased, or terminated, and if so, the effective date of such change (38U.S.C. 3034(a),
3241, 3474, 3524, 3680(a), and 10 U.S.C 510, 1636(b), and chapter 1607). Title 38, U.S.C., allows us to ask for
this information. Valid OMB control numbers can be located on the OMB Internet Page at
www.whitehouse.gov/omb/library/OMBINV.VA.EPA.htm#VA . If desired, you can call 1-888-GI-BILL-1
(1-888-442-4551) to get information on where to send your comments or suggestions about this form.
OMB Approved No. 2900-0156
Respondent Burden: 10 Minutes
NOTICE OF CHANGE IN STUDENT STATUS
1. NAME OF STUDENT (First, Middle, Last)
2. VA FILE NO. (For chapter 35, include suffix. For
transferability cases, enter the veteran’s Social Security Number)
3. CURRENT ADDRESS OF STUDENT
4. SOCIAL SECURITY NO. OF APPLICANT (If not entered in Item 2 above)
5. DATES OF TERM AFFECTED
A. BEGIN DATE
B. END DATE
6. TERMINATION (Complete Items A and B, and C if applicable)
A. LAST DATE OF
ATTENDANCE
B. REASON FOR TERMINATION
WITHDRAWAL BEFORE BEGINNING OF TERM
END OF TERM OR COURSE
WITHDRAWAL DURING DROP PERIOD
UNSATISFACTORY ATTENDANCE, CONDUCT, OR PROGRESS
WITHDRAWAL AFTER DROP PERIOD - NONPUNITIVE
GRADES ASSIGNED (If checked, complete Items 9 & 11)
GRADUATION
WITHDRAWAL AFTER DROP PERIOD - PUNITIVE
GRADES ASSIGNED
OTHER (Explain in Item 12, Remarks)
(Noncollege Degree Programs not on
WITHDRAWAL OR INTERRUPTION term basis - see Instructions)
C. LAST DATE CREDIT ACCRUED (For non-college degree courses only)
7. ADJUSTMENT OF CREDIT OR CLOCK HOURS (Complete Items A, B, and C thru H as applicable)
A. DATE ADJUSTMENT
IS EFFECTIVE
B. TYPE OF ADJUSTMENT
INCREASE
REDUCTION AFTER DROP PERIOD - PUNITIVE GRADES ASSIGNED
INCREASE ON FIRST DAY OF TERM
STUDENT COMPLETED TERM, BUT NONPUNITIVE GRADES ASSIGNED
FOR ONE OR MORE COURSES (If checked, complete Items 9 & 11)
REDUCTION ON FIRST DAY OF TERM
REDUCTION (Noncollege Degree Programs not on term basis- see Instructions)
REDUCTION DURING DROP PERIOD
OTHER (Explain in Item 12, Remarks)
REDUCTION AFTER DROP PERIOD - NONPUNITIVE
GRADES ASSIGNED (If checked, complete Items 9 & 11)
C. CREDIT HOURS BEFORE ADJUSTMENT
D. CREDIT HOURS AFTER ADJUSTMENT
F. CLOCK HOURS OR HIGH SCHOOL UNITS BEFORE
ADJUSTMENT
E. TRAINING TIME AFTER ADJUSTMENT (For graduate and advanced
professional)
FULL TIME
3/4 TIME
LESS THAN 1/2
1/4 TIME OR LESS
G. CLOCK HOURS OR HIGH SCHOOL UNITS AFTER
ADJUSTMENT
8. CHARGES FOR PERIOD OF ENROLLMENT (Complete this item for in-service
students, chapter 33 students, and for students whose training load after adjustment
is less than 1/2 time. List customary charges of the adjusted load by school year,
term, or other period. This item does not apply to students receiving chapter 32 or
1606 benefits)
1/2 TIME
H. REVISED ENDING DATE
B. TUITION AND FEES
$
9. DO PREVIOUS CERTIFICATIONS FOR SUBSEQUENT TERMS REMAIN UNCHANGED? 10. CALL-UP TO ACTIVE DUTY (Complete if student called to active
duty - see Instructions)
YES
NO
STUDENT CALLED UP - NO CREDIT
STUDENT CALLED UP - CREDIT
MITIGATING CIRCUMSTANCES (Complete only if indicated by Item 6 or 7)
11. DOES THE STUDENT CLAIM THAT TERMINATION OR ADJUSTMENT ACTIONS INVOLVED MITIGATING CIRCUMSTANCES?
YES
NO
12. REMARKS
UNKNOWN (If "Yes," attach student’s statement together with the student’s supporting evidence)
IT IS HEREBY CERTIFIED THAT the student’s status changed on the date indicated and in accordance with the facts shown above.
13A. DATE
VA FORM
NOV 2008
13B. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL
22-1999b
13C. NAME AND ADDRESS OF SCHOOL OR TRAINING ESTABLISHMENT
(Include Facility Code)
EXISTING STOCK OF VA FORM 22-1999b, AUG 2005,
WILL BE USED.
VA Copy 1
OMB Approved No. 2900-0156
Respondent Burden: 10 Minutes
NOTICE OF CHANGE IN STUDENT STATUS
1. NAME OF STUDENT (First, Middle, Last)
2. VA FILE NO. (For chapter 35, include suffix. For transferability cases,
enter the veteran’s Social Security Number)
3. CURRENT ADDRESS OF STUDENT
4. SOCIAL SECURITY NO. OF APPLICANT (If not entered in Item 2 above)
5. DATES OF TERM AFFECTED
A. BEGIN DATE
B. END DATE
6. TERMINATION (Complete Items A and B, and C if applicable)
A. LAST DATE OF
ATTENDANCE
B. REASON FOR TERMINATION
WITHDRAWAL BEFORE BEGINNING OF TERM
END OF TERM OR COURSE
WITHDRAWAL DURING DROP PERIOD
UNSATISFACTORY ATTENDANCE, CONDUCT, OR PROGRESS
WITHDRAWAL AFTER DROP PERIOD - NONPUNITIVE
GRADES ASSIGNED (If checked, complete Items 9 & 11)
GRADUATION
WITHDRAWAL AFTER DROP PERIOD - PUNITIVE
GRADES ASSIGNED
OTHER (Explain in Item 12, Remarks)
(Noncollege Degree Programs not on
WITHDRAWAL OR INTERRUPTION term basis - see Instructions)
C. LAST DATE CREDIT ACCRUED (For non-college degree courses only)
7. ADJUSTMENT OF CREDIT OR CLOCK HOURS (Complete Items A, B, and C thru H as applicable)
A. DATE ADJUSTMENT
IS EFFECTIVE
B. TYPE OF ADJUSTMENT
INCREASE
REDUCTION AFTER DROP PERIOD - PUNITIVE GRADES ASSIGNED
INCREASE ON FIRST DAY OF TERM
STUDENT COMPLETED TERM, BUT NONPUNITIVE GRADES ASSIGNED
FOR ONE OR MORE COURSES (If checked, complete Items 9 & 11)
REDUCTION ON FIRST DAY OF TERM
REDUCTION (Noncollege Degree Programs not on term basis- see Instructions)
REDUCTION DURING DROP PERIOD
OTHER (Explain in Item 12, Remarks)
REDUCTION AFTER DROP PERIOD - NONPUNITIVE
GRADES ASSIGNED (If checked, complete Items 9 & 11)
C. CREDIT HOURS BEFORE ADJUSTMENT
D. CREDIT HOURS AFTER ADJUSTMENT
F. CLOCK HOURS OR HIGH SCHOOL UNITS BEFORE
ADJUSTMENT
E. TRAINING TIME AFTER ADJUSTMENT (For graduate and advanced
professional)
FULL TIME
3/4 TIME
LESS THAN 1/2
1/4 TIME OR LESS
G. CLOCK HOURS OR HIGH SCHOOL UNITS AFTER
ADJUSTMENT
8. CHARGES FOR PERIOD OF ENROLLMENT (Complete this item for in-service
students, chapter 33 students, and for students whose training load after adjustment
is less than 1/2 time. List customary charges of the adjusted load by school year,
term, or other period. This item does not apply to students receiving chapter 32 or
1606 benefits)
1/2 TIME
H. REVISED ENDING DATE
B. TUITION AND FEES
$
9. DO PREVIOUS CERTIFICATIONS FOR SUBSEQUENT TERMS REMAIN UNCHANGED? 10. CALL-UP TO ACTIVE DUTY (Complete if student called to active
duty - see Instructions)
YES
NO
STUDENT CALLED UP - NO CREDIT
STUDENT CALLED UP - CREDIT
MITIGATING CIRCUMSTANCES (Complete only if indicated by Item 6 or 7)
11. DOES THE STUDENT CLAIM THAT TERMINATION OR ADJUSTMENT ACTIONS INVOLVED MITIGATING CIRCUMSTANCES?
YES
NO
12. REMARKS
UNKNOWN (If "Yes," attach student’s statement together with the student’s supporting evidence)
IT IS HEREBY CERTIFIED THAT the student’s status changed on the date indicated and in accordance with the facts shown above.
13A. DATE
VA FORM
NOV 2008
13B. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL
22-1999b
13C. NAME AND ADDRESS OF SCHOOL OR TRAINING ESTABLISHMENT
(Include Facility Code)
EXISTING STOCK OF VA FORM 22-1999b, AUG 2005,
WILL BE USED.
VA Copy 2
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |